1990年至2021年全球因肾功能不全导致的缺血性心脏病负担及到2050年的预测：全球疾病负担研究2021的结果
Global ischemic heart disease burden attributable to kidney dysfunction from 1990 to 2021 and projections to 2050: results from the global burden of disease study 2021.
作者信息
Xia Meng, Shi Yingchao, Zhu Hongtao, Ji Yanan
机构信息
Faculty of Biochemical and Environmental Engineering, Baoding University, Baoding, China.
Key Laboratory of Cardiovascular Regenerative Medicine, Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Zhengzhou, China.
出版信息
Front Cardiovasc Med. 2025 May 23;12:1601549. doi: 10.3389/fcvm.2025.1601549. eCollection 2025.
BACKGROUND
Ischemic heart disease (IHD) is the leading cause of death of non-communicable diseases globally, presenting with particularly prominent metabolic risk associated with kidney dysfunction in the middle-aged and older populations. Accordingly, the present study intended to clarify trends in IHD burden attributable to kidney dysfunction from 1990 to 2021, with projection to 2050, in the middle-aged and older populations.
METHODS
This study quantified the burden of IHD attributable to kidney dysfunction in middle-aged and older populations from 1990 to 2021 through deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) based on the estimated annual percentage change (EAPC). Autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were adopted to predict the changing trends of IHD burden attributable to kidney dysfunction from 2022 to 2050.
RESULTS
Between 1990 and 2021, both global deaths (from 0.83 million to 1.40 million) and DALYs (from 16.2 million to 26.1 million) from IHD attributable to kidney dysfunction increased in the studied populations. Despite rising absolute numbers, age-standardized death (ASDR) and DALY rates (ASDAR) declined significantly, with EAPC of -0.54 (95% CI: -0.97 to -0.11) and -0.55 (95% CI: -0.85 to -0.25) respectively, primarily driven by regions with high and high-middle SDI. Sex-specific analyses revealed steeper declines among females (ASDR EAPC: -1.71; ASDAR EAPC: -1.55) than males (ASDR EAPC: -1.18; ASDAR EAPC: -1.09), even with consistently higher rates in males. Age-stratified data showed peak ASRs in the >95 age group in 2021, despite consistent rate reductions across all age cohorts since 1990. Projections suggested continued growth in absolute burden through 2050, accompanied by sustained declines in ASDR and ASDAR, revealing both aging and improved age-adjusted disease management over time.
CONCLUSION
This study suggests a decline in the global age-standardized IHD (ASDR/ASDAR) attributable to kidney dysfunction over three decades, yet accompanied by substantial absolute burden, disproportionately impacting lower SDI regions, males and the elderly. Projection to 2050 highlights a rising burden, necessitating prioritized resource allocation, enhanced health literacy, and evidence-based prevention targeting high-risk populations.
背景
缺血性心脏病（IHD）是全球非传染性疾病的主要死因，在中老年人群中，与肾功能障碍相关的代谢风险尤为突出。因此，本研究旨在阐明1990年至2021年以及预测到2050年，中老年人群中肾功能障碍所致缺血性心脏病负担的趋势。
方法
本研究通过死亡人数、伤残调整生命年（DALYs）和年龄标准化率（ASRs），基于估计的年度百分比变化（EAPC），对1990年至2021年中老年人群中肾功能障碍所致缺血性心脏病的负担进行了量化。采用自回归积分移动平均（ARIMA）和指数平滑（ES）模型预测2022年至2050年肾功能障碍所致缺血性心脏病负担的变化趋势。
结果
1990年至2021年期间，研究人群中因肾功能障碍导致的缺血性心脏病全球死亡人数（从83万增至140万）和伤残调整生命年（从1620万增至2610万）均有所增加。尽管绝对数量在上升，但年龄标准化死亡率（ASDR）和伤残调整生命年率（ASDAR）显著下降，EAPC分别为-0.54（95%CI：-0.97至-0.11）和-0.55（95%CI：-0.85至-0.25），主要由高社会人口指数（SDI）和高中等SDI地区推动。按性别进行的分析显示，女性（ASDR的EAPC：-1.71；ASDAR的EAPC：-1.55）的下降幅度比男性（ASDR的EAPC：-1.18；ASDAR的EAPC：-1.09）更大，尽管男性的发病率一直较高。按年龄分层的数据显示，2021年9五岁以上年龄组的年龄标准化率最高，尽管自1990年以来所有年龄组的发病率都在持续下降。预测表明，到2050年绝对负担将持续增加，同时ASDR和ASDAR将持续下降，这表明随着时间的推移，老龄化和年龄调整后的疾病管理得到了改善。
结论
本研究表明，在三十年中，全球因肾功能障碍导致的年龄标准化缺血性心脏病（ASDR/ASDAR）有所下降，但同时伴随着巨大的绝对负担，对低SDI地区、男性和老年人的影响尤为严重。到2050年的预测突出了负担的上升，这需要优先分配资源、提高健康素养，并针对高危人群进行循证预防。
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